Lesbianism : a post-structural/post-modernist critique of selected theories relevant to clinical practice

Bibliography: leaves 41-46.This paper aims to provide a critical framework from which to review the major trends in psychiatry and psychoanalysis pertaining to lesbianism and relevant to clinical practice. The post-structuralist/post-modernist framework employed considers lesbianism as a category constructed in a particular socio-historical context and involving particular power relations. The role of psychiatry and psychoanalysis in this process of categorisation and the production and reproduction of lesbianism as pathology relative to a heterosexual norm will also be examined. On the other hand, challenges to the lesbianism as pathology thesis, drawing on more radical psychoanalytic concepts, influencing and also influenced by post-structuralist/post-modernist theories will be discussed. Various suggestions flowing from a post-structuralist/post-modernist analysis and which may be useful in a clinical context will also be presented

La GAC 1 : grille d’analyse du contre-transfert dans le traitement des troubles graves de la personnalité

Cet article met en relief le rôle central des réactions contre-transférentielles dans le traitement de patients limites selon l’approche focalisée sur le transfert de Otto F. Kernberg (TFP : Transference Focused Psychotherapy). Une grille d’analyse du contre-transfert (GAC) est présentée pour décrire la diversité des activités mentales dans lesquelles le thérapeute s’engage pour comprendre et parvenir à utiliser les réactions que déclenchent en lui ces patients. Un exemple clinique est présenté pour démontrer l’utilité de la GAC dans le travail des réactions contre-transférentielles évoquées par une patiente présentant un trouble limite de la personnalité. Certaines données de recherche viennent appuyer l’importance du travail des réactions contre-transférentielles.This paper introduces the central role of countertransference reactions in the treatment of borderline patients in transference focused psychotherapy developed by Otto F. Kernberg. The Countertransference Rating System is presented to illustrate the diversity of the therapist’s mental activities involved in his attempts to process and use reactions call to mind by borderline patient. A clinical example is presented as such as empirical evidence in support of the usefulness of the CRS and of the importance of processing countertransference reactions.Este artículo pone de relieve el papel central de las reacciones contratransferenciales en el tratamiento de pacientes límite, según el enfoque focalizado sobre la transferencia de Otto F. Kernberg (TFP : Transference Focused Psychotherapy). Se presenta un cuadro de análisis de la contratransferencia (GAC) para describir la diversidad de las actividades mentales con las que el terapeuta se compromete para comprender y lograr utilizar las reacciones que provocan en él estos pacientes. Se presenta un ejemplo clínico para demostrar la utilidad del GAC en el trabajo de las reacciones contratransferenciales evocadas por una paciente que presenta un trastorno de personalidad límite. Algunos datos de la investigación apoyan la importancia del trabajo de las reacciones contratransferenciales.Este artigo coloca em evidência o papel central das reações de contra-transferência no tratamento de pacientes borderline, segundo a abordagem focada na transferência de Otto F. Kernberg (TFP: Transference Focused Psychotherapy). É apresentado um sistema de análise da contra-transferência (grille d’analyse du contre-transfert - GAC) para descrever a diversidade das atividades mentais nas quais o terapeuta se introduz para compreender e chegar a utilizar as reações que estes pacientes suscitam nele. Um exemplo clínico é apresentado para demonstrar a utilidade da GAC no trabalho das reações de contra-transferência evocadas por uma paciente que apresenta um transtorno de personalidade borderline. Alguns dados de pesquisa vêm apoiar a importância do trabalho destas reações de contra-transferência

La psychothérapie focalisée sur le transfert (TFP) et le fonctionnement réflexif 1

Le fonctionnement réflexif (FR) est un concept relativement nouveau et renvoie à la capacité d’un individu d’interpréter les comportements humains et les réactions interpersonnelles en termes d’intentions sous-jacentes et d’états mentaux. Il est particulièrement important dans le processus de régulation des affects et de la gestion des relations interpersonnelles difficiles. Comparativement à la thérapie comportementale dialectique (DBT) et les thérapies de soutien, la thérapie focalisée sur le transfert (TFP) a l’unique avantage de produire des changements au niveau du FR des patients limites. Dans le présent article, nous adoptons une perspective développementale pour expliquer les changements au niveau du FR induit par la TFP. Nous proposons un certain nombre de mécanismes d’action thérapeutiques par lesquels la TFP agirait chez des patients limites et plus particulièrement dans l’interprétation du transfert..Reflective functioning is a relatively new concept which broadly speaking, refers to the capacity to interpret human behaviours and interpersonal reactions in terms of underlying intentions and mental state motivations. This capacity is particularly important in the regulation of affects and the management of challenging interpersonal relations. In comparison to dialectical behavioural therapy (DBT) and supportive therapies, transference focused psychotherapy (TFP) has been shown to have unique advantages in terms of producing improvements in RF of borderline patients. In the present article, we propose a developmental perspective for understanding how TFP produces these changes in RF. Using this perspective, we identify a number of therapeutic mechanisms through which TFP facilitate the development of RF and specifically transference interpretations.El funcionamiento reflexivo (FR) es un concepto relativamente nuevo y se refiere a la capacidad de un individuo de interpretar los comportamientos humanos y las reacciones interpersonales en términos de las intenciones subyacentes y los estados mentales. Es particularmente importante en el proceso de regulación de los afectos y la gestión de las relaciones interpersonales difíciles. Comparativamente a la terapia comportamental dialéctica (DBT) y las terapias de apoyo, la terapia centrada en la transferencia (TFP) tiene la única ventaja de producir los cambios a nivel del FR de los pacientes límite. En este artículo, adoptamos una perspectiva de desarrollo para explicar los cambios a nivel del FR inducido por la TFP. Proponemos un cierto número de mecanismos de acción terapéutica por medio de los cuales la TFP actuaría en los pacientes límite.O funcionamento reflexivo (FR) é um conceito relativamente novo e refere-se à capacidade de um indivíduo de interpretar os comportamentos humanos e as reações interpessoais em termos de intenções subjacentes e estados mentais. Ele é particularmente importante no processo de regulação dos afetos e da gestão das relações interpessoais difíceis. Em comparação à terapia comportamental dialética (DBT) e as terapias de apoio, a terapia focada na transferência (TFP) tem a única vantagem de produzir mudanças ao nível do FR dos pacientes borderline. No presente artigo, adotamos uma perspectiva do desenvolvimento para explicar as mudanças ao nível do FR induzido pela TFP. Propomos um certo número de mecanismos de ação terapêutica pelos quais a TFP agiria nos pacientes borderline

Post-traumatic stress disorder in children exposed to violence

The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary

Post-traumatic stress disorder in children exposed to violence

Objectives. To investigate to what extent local children exposed to community violence develop post-traumatic stress disorder (PTSD), whether the symptom profile is typical or atypical, and how detection can be improved.Design. A cross-sectional study of two samples of children with a high risk of past exposure to violence.Setting and subjects. Sixty Xhosa-speaking children aged 10 - 16 years; 30 from the Children's Home which serves Khayelitsha, and 30 from a school in a violent area of KhayelitshaOutcome measures. A shortened version of the Survey of Exposure to Community Violence (SECV) was administered to determine exposure to violence. Structured questionnaires and a clinical assessment were used to elicit symptoms and make psychiatric diagnoses.Results. All 60 children reported exposure to indirect violence, 57 (95%) had witnessed violence, and 34 (56%) had experienced violence themselves. Twenty-four (40%) met the criteria for one or more DSM-III-R diagnoses and 13 (21.7%) met the criteria lor PTSD.Conclusions. Community violence places children at a high risk of developing serious psychiatric disorders and many children develop PTSD. None of the children in the school sample had received intervention prior to the study, pointing towards an urgent need for increased community and professional awareness of children at risk

Response: behind the closed doors of mentalizing. A commentary on "Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale"

In this thought-provoking commentary on our findings regarding the dramatic deficits in mentalization specifically regarding past experiences of abuse and neglect in adults who otherwise demonstrate that they have the capacity to think about past relationships in terms of affects and mental states despite these histories, Schimmenti re-examines our findings from the perspective of dissociation and subtly raises the question of whether we adequately consider dissociative processes in the interpretation of our findings

Play completion predicts fewer child psychological difficulties: A longitudinal study of mentalizing processes

Play therapy is widely used with children, including children who experienced sexual abuse. This longitudinal study examined whether more pretend play completion (PPC) at Time 1 predicted fewer child difficulties when this was assessed 3 years later at Time 2. Participants were 91 children (aged 3–8 at Time 1), including 51 children who experienced sexual abuse (child sexual abuse [CSA]). Play was coded with the Children’s Play Therapy Instrument, and child psychological difficulties were assessed with the Child Behavior Checklist. More PPC at Time 1 predicted fewer child psychological difficulties 3 years later at Time 2. This was the case in children who had experienced CSA as well as the comparison group, showing that PPC is predicts better psychological adjustment in both abused and nonabused children. The study provides the first longitudinal evidence of the important role of pretend play narrative completion in predicting less internalizing and externalizing difficulties. The findings have important clinical implications for play therapists. It suggests that interventions that encourage children to elaborate and complete their play narratives could facilitate agency and psychological adjustment, as well as recovery after trauma. This is in line with the idea that through play children discover that they can “play with reality” and gain control over how they tell their stories. (PsycInfo Database Record (c) 2023 APA, all rights reserved

Measuring Grandiose and Vulnerable Narcissism in Adolescents

The Pathological Narcissism Inventory (PNI) has been widely used with adults. Its vulnerable and grandiose dimensions have been differentially associated with psychopathology and interpersonal difficulties. While the PNI has been used with adolescents, its structure and correlates remain to be investigated. The aim of this study was to examine the psychometric properties of the French PNI for adolescents and its association with indices of dysfunction. A total of 570 adolescents completed the PNI, the Youth Self Reportto assess internalizing and externalizing difficulties, and the Self-Perception Profile for Adolescents to assess self-esteem. Results showed that the first and second-order factor structure of the PNI for adolescents is identical to the one found in adults. Temporal stability at one month was good. Between gender differences, as well as correlations between PNI dimensions, internalizing and externalizing difficulties, and self-esteem further add to the conclusion that the French PNI-A has good psychometric properties. Key words: adolescence, narcissism, measure, french, pathological narcissism inventor

Post-traumatic-stress in the context of childhood maltreatment: pathways from attachment through mentalizing during the transition to parenthood

INTRODUCTION: This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles. METHOD: Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF). RESULTS: Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant. DISCUSSION: This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important during the transition to parenting when activation of representations of parenting can trigger PTSS

El papel protector de mentalización de experiencias traumáticas implicaciones al entrar en la parentalidad

Es ampliamente reconocido que las experiencias de abuso y trauma en la infancia, especialmente aquellas que tienen lugar en un contexto de apego inseguro, obstaculizan el desarrollo del sentimiento fundamental de seguridad en relación con el otro; dejando así las víctimas con un sentimiento de soledad y afectos y dolor que no pueden ser compartidos y vinculados a lo trauma. A su vez, cuando estos niños crecen y se convierten en padres, siguen siendo extremadamente vulnerables a la desorganización y confusión cuando confrontados al desamparo de sus hijos. Esto los hace más propensos a reaccionaren de manera inapropiada, teniendo en cuenta la activación de los efectos ligados al trauma no resuelto. Sin embargo, como Selma Fraiberg demonstró, los padres aptos para haceren frente a experiencias traumáticas y a los llamados "fantasmas del pasado" tenen menor riesgo de transmitir el trauma a sus hijos. Esto sugiere que la mentalización es un factor importante de resiliencia.It is widely recognized that experiences of abuse and trauma in childhood, particularly those that take place in the context of attachment relationships, hamper the development of a fundamental sense of security in relation to others; leaving the victims with a deep sense of loneliness and unbearable affects and pain associated with the trauma that cannot be shared.. When abused children grow up and become parents in turn, they remain extremely vulnerable to disorganization and confusion when facing the helplessness of their children. This leaves them more likely to react inappropriately when affects linked to unresolved trauma are activated. However, as demonstrated by Fraiberg, those parents who are able to face traumatic experiences and so-called "ghosts of the past" have a lower risk of transmitting trauma to their children. This suggests that mentalizing is an important factor of resilience.Já é amplamente reconhecido que as experiências de abuso e de trauma na infância, particularmente as que se passam em um contexto de apego sem segurança, prejudicam o desenvolvimento do sentimento fundamental de segurança em relação ao outro, deixando, desse modo, as vítimas com um sentimento de solidão e com afetos e dores que não podem ser partilhados e associados ao trauma. Por sua vez, quando essas crianças crescem e tornam-se pais, permanecem extremamente vulneráveis à desorganização e à confusão quando confrontados ao desamparo de seus filhos. Isso os torna ainda mais passíveis de reagir de modo impróprio, considerando a ativação dos efeitos ligados ao trauma não resolvido. Entretanto, tal como demonstrado por Fraiberg, os pais aptos para fazer face às experiências traumáticas e aos chamados "fantasmas do passado" têm menor risco de transmitir o trauma a seus filhos. Isso sugere que a mentalização é um fator importante de resiliência